Who Can Diagnose?

SDN Members don't see this ad. (About Ads)

I wanted to know who can diagnose psychological disorders. I know it varies from state to state, but what are the general requirements? Thank you.

In Utah, I am able to diagnose psychological disorders. I am a Master's level mental health counselor. So do MSWs, LMFTs, etc. If you are an intern, including student intern, you can do everything that your supervisor is qualified to do and willing to sign for you to do.

in NY, where I am licensed as a mental health counselor, we have the ability to use the DSM IV to "assess." This is to preserve the ability for social workers to maintain a "leg up" in the field as mid-level practicioners. It basically means we (LMHC's) can still operate in private practice and in county facilities but some agencies choose to keep it all LSCW strictly for this reason. My wife is an LCSW and our training in NY is essentially the same, including courses in psychophathology and diagnosing, and the licensing test form LMHC's is almost entirely dependent on diagnostic ability.

In Ca., Co. and Wy all licensed mental health providers (LPC, LCSW, MFT etc..) can diagnose with the exception that in Wy mid-level providers need a cosignature from a doctor (MD/PhD/PsyD) to bill medicaid.

There is also a difference between who can diagnose legally and who can diagnose ethically. For example, a provider unfamiliar with the various Dx's along the autism spectrum should not make a diagnosis in that area, though many times they still do. I bring this up because I often see diagnoses that are in direct conflict with each other (the differential is an either/or scenario), yet they appear together. It is my personal belief that a diagnosis should require a full clinical interview and formal psychological testing. Until this can happen the diagnosis should include rule outs and a formal diagnosis should only be made after more information can be collected. Admittedly this is not realistic in some circumstances, but it may help clear up some of the treatment issues we encounter later on.

I recently was consulted on a case where the diagnosis was unclear and the clinician did not feel comfortable making a formal diagnosis without significant psychological and neuropsychological testing. The provider is a very seasoned clinician who legally could make the diagnosis, but ethically she was not comfortable to do so. I point this out because instead of putting something down that didn't full capture the symptoms (which is what previous providers did), she deferred the diagnosis until she had more information.

So to answer the OP....in the majority of states most licensed mental health providers can provide a diagnosis....but many should not, but still do. Included in this statement are both MA/MS and Ph.D/Psy.D/MD.

In Tennessee, you must be a Licensed Mental Health Provider (this is at the masters level, I am unfamiliar if this label is also necessary at the doctoral level).

The LMHP is one step past being a licensed professional counselor/clinical social worker/etc as it requires more experience (and, I believe, experience in a setting with mental illness) and more specific courses in DSM/psychopathology, etc. The LMHP in our state is also what enables more insurance providers to reimburse for services.

Originally Posted by stigmata

In Ca., Co. and Wy all licensed mental health providers (LPC, LCSW, MFT etc..) can diagnose with the exception that in Wy mid-level providers need a cosignature from a doctor (MD/PhD/PsyD) to bill medicaid.

While many masters level providers are diagnosing in CA(MFTs and LCSWs), it is not clearly written in the licensure laws and both professions have attempted to have their scope of practice amended to include the terms diagnosis of mental and emotional disorders. The term psychotherapy or psychotherapeutic techniques is written in the licensure laws of these professions which allows the treatment of mental and emotional disorders. MFTs had their scope amended to include utilizing the training they are provided which infers the ability to diagnose as it is a requirement of the training to become a MFT in CA. The LPCC licensure law that just passed in CA is similar to the other professions mentioned. Of non physicians, only the psychologist licensure law clearly states diagnosis as within the scope.

Thanks, everyone!

I basically was just curious to know if Master's-level practitioners could do it.

Interestingly enough, Indiana is one of the few states that prohibits master level practitioners from diagnosing. We can "assess" for mental health, applying diagnostic coding, submit for insurance reimbursement, etc. but cannot legally diagnose. The law was actually created because a nurse in the state felt it was wrong for master level practitioners to diagnose. She felt because nurses couldn't diagnose (and in her view master level practitioners were the nurses of psychologists) master level therapists shouldn't be permitted to either.

I find this a bit disturbing as we can "assess" but can't make a legal diagnosis. Although, in practice we diagnose everyday, and the MD signs off on it.

It also irks me that family practitioners can make a mental health diagnosis but master level therapists can't. This is absurd!